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Levonorgestrel (LNG)-intrauterine devices (IUDs) are an effective method of contraception; however, there is growing evidence regarding potential psychiatric side effects such as depressive symptoms, anxiety, and suicidal thoughts. Therefore, we conducted this systematic review to summarise the psychiatric effects of using LNG-IUDs.We searched six databases (MEDLINE, Web of Science, Scopus, Science Direct, Cochrane Library, and PsycInfo), and we included all study designs. The included studies were extracted, quality assessed, and qualitatively summarised.Out of the screened studies, only 22 were finally included. While ten studies showed increased depressive symptoms, two studies showed reduced symptoms. Moreover, one study showed increased anxiety, another one reported an increased risk of suicide, four studies concluded no association with depressive symptoms, and four other studies showed uncertainty about a potential association but mentioned other psychiatric symptoms.Despite unreliable data, many studies report psychiatric symptoms associated with LNG-IUDs, predominantly depression. Gynaecologists, general practitioners, and psychiatrists should therefore be aware of these potential risks, especially depressive symptoms and suicidality. Counselling patients about these risks should be mandatory. Further studies should investigate the absolute risk of mental disorders associated with LNG-IUDs and other hormonal contraceptives.KEY MESSAGESMany researchers are reporting adverse psychiatric events associated with levonorgestrel intrauterine devices (LNG-IUDs).Despite their effectiveness, a proper psychiatric assessment should be done before inserting LNG-IUDs.Proper counselling regarding the depressive symptoms and suicidality should be done by the treating obstetrician.Further studies should investigate the absolute risk of mental disorders associated with LNG-IUDs and other hormonal contraceptives.

The coronavirus disease 2019 (COVID-19) pandemic has had a marked impact on psychiatry. Capacity reductions also affected electroconvulsive therapy (ECT), even though ECT is an essential rather than an elective procedure. We sent a survey to all 197 clinics in Germany, Austria, and Switzerland with an ECT service between March and May 2021 to provide an overview of the changes made to ECT services in these countries during the acute phase of the COVID-19 pandemic. More than a quarter of the clinics (27.0%) reported a temporary suspension of all ECT treatments, and 28.2% of the clinics reported reductions of up to 75%. Maintenance ECT was suspended in 46.7% of the clinics and reduced by up to 75% in 30.6% of the clinics. At the time of the survey, 40.8% of the clinics still reported lower numbers of ECT treatments compared with the prepandemic situation. Reasons for the reduced number of ECT treatments included patient safety and testing measures, personnel shortages in the anesthesiology departments, and limited availability of rooms. The COVID-19 pandemic had and continues to have a marked negative impact on the provision of ECT in clinics in Germany, Austria, and Switzerland. To avoid negative consequences for patients, ECT clinics should urgently take steps to provide ECT services without disruptions.

ZUSAMMENFASSUNG Hintergrund Die Diagnose einer schizoaffektiven Störung (SAS) weist im Vergleich zu anderen psychischen Erkrankungen eine nur sehr niedrige Interrater-Reliabilität auf. Eine mögliche Ursache hierfür kann in Unterschieden diagnostischer Kriterien zwischen den verschiedenen Klassifikationssystemen ICD-10 und DSM-5 liegen, die mit dieser Arbeit untersucht werden sollen. Insbesondere werden auch die Abweichungen zwischen verschiedenen Ausgaben der ICD-10 berücksichtigt. Methode Die Kriterien zur Diagnose der SAS im Taschenführer zur ICD-10, in den klinisch-diagnostischen Leitlinien zur ICD-10 sowie im DSM-5 wurden systematisch miteinander verglichen. Ebenso berücksichtigt wurden hierbei die Ausschlusskriterien verwandter psychischer Störungen. Ergebnisse Alle 3 genannten Klassifikationssystemen stimmen darin überein, dass die SAS durch affektive Symptome und mindestens ein schizophrenes Symptom einer Schizophrenie charakterisiert ist. Deutliche Unterschiede liegen jedoch in der genauen Symptomspezifikation, der für die Diagnose erforderlichen Dauer und zeitlichen Überlappung der Symptome, den Ausschlusskriterien und in möglichen Zusatzkodierungen (insbesondere Remissionen). Schlussfolgerung Sowohl zwischen DSM-5 und ICD-10 als auch zwischen den zur Verfügung stehenden Versionen der ICD-10 unterscheiden sich die Diagnosekriterien einer SAS zum Teil deutlich. Dieser Artikel soll eine Übersicht zur Vereinfachung der Kommunikation bieten. Bei der Einführung der ICD-11 ist darauf zu achten, innerhalb dieses Manuals einheitlicher zu werden und einen besseren Übergang zum DSM-5 zu ermöglichen.

Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field.The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations.Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.

Zusammenfassung Ziel der Studie Mobbing am Arbeitsplatz gilt als interpersoneller Stressfaktor. Beruflicher Stress und mentale Gesundheit bei Ärztinnen und Ärzten rücken zunehmend in den Fokus der Öffentlichkeit. Inwiefern Mobbing dabei eine Rolle spielt ist noch kaum untersucht. Die Studie soll daher Daten zu Prävalenz von Mobbing unter KlinikärztInnen in Deutschland und möglichen Zusammenhängen mit beruflichem Stress und mentaler Gesundheit liefern. Methoden Im Rahmen zweier Querschnittstudien wurden 692 KlinikärztInnen des Fachgebietes Psychiatrie/Psychotherapie (P/PT) und 667 KlinikärztInnen der Intensivmedizin (IM) auf Kongressen befragt. Zum Einsatz kamen standardisierte Fragebögen zu Mobbingerfahrung, Berufsstress und mentaler Gesundheit (Einzelitem aus dem COPSOQ, BDI-II, ERI, MBI). Ergebnisse Mobbing erlebten 4,6% (N=61) der Befragten. In der Tendenz sind IM und Frauen häufiger betroffen (nicht signifikant) und es zeigten sich Korrelationen mit Berufsstress (ERI), Overcommitment (OC), Emotionaler Erschöpfung (MBI) und Depressivität (BDI-II). Schlussfolgerung Unsere Daten an einer großen Kohorte von Ärztinnen und Ärzten in Fachgebieten mit unterschiedlichem Belastungsprofil zeigen, dass ein nicht unerheblicher Anteil von Mobbing betroffen ist und Mobbing in Zusammenhang mit dem Erleben von Berufsstress sowie Beeinträchtigungen der mentalen Gesundheit stehen. Daraus lassen sich Implikationen zu institutionellen und individuellen Präventions- und Unterstützungsangeboten ableiten.

Neuroinflammation has been connected to the pathophysiology of major depressive disorder (MDD) and neurochemical biomarkers of glial pathology could aid the diagnosis and might support patient stratification and monitoring in clinical trials. Our study aimed to determine the utility of glial fibrillary acidic protein (GFAP), a marker of astrocyte activation, for the differential diagnosis and monitoring of MDD. Employing Simoa technology we measured levels of GFAP in prospectively collected serum samples from 81 age-matched patients with MDD, schizophrenia (SZ), bipolar disorder (BP), and healthy controls (HC). Highest GFAP levels were determined for MDD. At a cut-off of 130 pg/ml, MDD could be discriminated with 87% sensitivity from SZ and BP (specificity 70%) and from HC (specificity 56%). GFAP levels increased with age (r = 0.5236, p = 0.0002) and with MDD severity quantified based on the Montgomery-Asberg Depression Rating Scale (r = 0.4308, p = 0.0221). Neurofilament light chain serum levels were not different in the diagnostic groups and not associated with GFAP levels (r = 0.0911, p = 0.576) pointing to an independence of astrocyte activation on neurodegeneration. Our study provides first evidence that serum GFAP levels could improve the differential diagnosis of MDD and that depression severity could be objectively quantified using serum GFAP levels. Furthermore, serum GFAP might represent a marker to monitor astroglial pathology in the course of MDD.

Catatonia is an underdiagnosed psychomotor syndrome that can occur in the context of various mental and somatic diseases. Malignant catatonia is particularly relevant in the context of intensive medical care. Clear recommendations in guidelines are missing.To present the current state of the diagnosis and treatment of catatonia, especially malignant catatonia.The literature was evaluated with respect to acute catatonic conditions, with a special focus on the differential diagnosis, relevance to intensive medical care and treatment of catatonia.In psychiatric inpatients, catatonic syndromes are relatively frequent with a prevalence between 9% and 17%, and in neurological patients somewhat less frequent with a prevalence of 3.3%. There is a clear recommendation for pharmacological treatment with lorazepam. Additional electroconvulsive therapy (ECT) should be considered as early as possible, especially in cases not responding to benzodiazepines. Response rates to ECT have been shown to be 80-100%. In malignant catatonia, ECT should be performed immediately as an emergency indication.Several factors lead to the underdiagnosis of catatonia. It is problematic that even life-threatening malignant catatonia is often not recognized as such, although there is a mortality of about 50% if untreated. The best treatment outcome is achieved with a combination of benzodiazepines and ECT. The treatment of severe malignant catatonia represents an emergency indication for ECT.HINTERGRUND: Bei der Katatonie handelt es sich um ein unterdiagnostiziertes psychomotorisches Syndrom, das im Zusammenhang mit verschiedenen psychischen und somatischen Erkrankungen auftreten kann. Es wird insbesondere in Form der perniziösen Katatonie intensivmedizinisch relevant. Hierzu gibt es nur wenige detaillierte Empfehlungen in Leitlinien.Darstellung des aktuellen Standes der Diagnostik und Therapie von Katatonien, insbesondere der perniziösen Katatonie.Die Literatur wurde im Hinblick auf akute katatone Zustände evaluiert, mit einem besonderen Fokus auf Differenzialdiagnostik, intensivmedizinische Relevanz und die Therapie von Katatonien.Bei stationär psychiatrisch behandelten Patient*innen sind katatone Syndrome mit einer Prävalenz zwischen 9 und 17 % recht häufig, bei neurologischen Patient*innen mit einer Prävalenz von 3,3 % etwas seltener. Es gibt eine klare Empfehlung für eine medikamentöse Behandlung mit Lorazepam. Insbesondere bei fehlendem Ansprechen auf Benzodiazepine ist unbedingt zeitnah an eine zusätzliche Elektrokonvulsionstherapie (EKT) zu denken, die Ansprechraten von 80–100 % zeigt. Bei perniziösen Katatonien kann die EKT unverzüglich als Notfallindikation durchgeführt werden.Katatonien werden im klinischen Kontext deutlich zu selten erkannt. Problematisch ist, dass auch lebensbedrohliche perniziöse Katatonien häufig nicht als solche erkannt werden, obwohl deren Letalität unbehandelt bei ca. 50 % liegt. Das beste Behandlungsergebnis wird bei einer Kombination von Benzodiazepinen und EKT erzielt. Die Behandlung der schweren, perniziösen Katatonie stellt eine Notfallindikation zur EKT dar.

ZusammenfassungWir berichten über den Fall einer Sulpirid-induzierten Dystonie bei einem Patienten mit einem bekannten Tourette Syndrom. Aufgrund des plötzlichen Auftretens einer schlaganfallähnlichen Symptomatik während einer körperlichen Belastung war die eigentliche Dystoniediagnose erschwert. Nach Ausschluss einer vaskulären Ursache (Blutung, Gefäßdissektion, etc.) durch geeigneter Bildgebung wurde Biperiden infundiert, welche zum sofortigen Verschwinden der Dystonie führte.

Background To date, disproportionality analysis has been unable to demonstrate the increased bleeding risk associated with antidepressant drugs, especially selective serotonin reuptake inhibitors. Objective We hypothesised that a potential signal for an increased bleeding risk may be mitigated by the effects of agents other than antidepressant drugs that are strongly associated with haemorrhages, especially antithrombotics. In addition, we investigated if the use of more specific search terms of the Medical Dictionary for Regulatory Activities facilitates the detection of signals. Methods Pharmacovigilance data from the Uppsala Monitoring Centre were used to calculate substance-specific reporting odds ratios (RORs) for all types of bleeding and gastrointestinal bleeding. Reporting odds ratios were calculated with and without antithrombotic comedication. Results Regarding any type of bleeding, no signals were found in association with antidepressant drugs. Concerning upper gastrointestinal bleeding, signals were found related to citalopram (ROR: 1.56 [95% confidence interval 1.11–2.20]) and escitalopram (ROR: 1.52 [95% confidence interval 1.03–2.25]). After removal of reports related to antithrombotics, these signals could no longer be detected, but a new signal related to St. John’s Wort associated with haemorrhages was found (ROR: 1.50 [95% confidence interval 1.21–1.86]). Conclusions Antithrombotics seem unlikely to have a major impact on the detection of the bleeding risk of antidepressant drugs. The different categorisation of adverse drug reactions regarding the strength of a causal relationship between a drug and an event in the database may be relevant for this negative finding. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00260-9.

Drug-associated liver injury is one of the most common causes for acute liver failure and market withdrawal of approved drugs. In addition, the potential for hepatotoxicity related to specific substances has to be considered in psychopharmacotherapy. However, systematic evaluations of hepatotoxicity related to antipsychotics are limited.We conducted an exploratory case/non-case study and evaluated pharmacovigilance data from VigiBase related to 30 antipsychotics marketed in the European Union. Reporting odds ratios were calculated for antipsychotics associated with the Standardized Medical Dictionary of Regulatory Activities queries "Drug-related hepatic disorders-comprehensive search" (DRHD-CS) and "Drug-related hepatic disorders-severe events only" (DRHD-SEO).We found several signals for drug-associated liver injury including signals for severe events: 17 of 30 antipsychotics were associated with DRHD-CS and 10 of 30 antipsychotics with DRHD-SEO. Amisulpride, fluphenazine, levomepromazine, loxapine, olanzapine, perazine, perphenazine, pipamperone, sulpiride, and thioridazine were associated with both, DRHD-CS and DRHD-SEO. No association with fatal outcomes was detected.Several common antipsychotics are associated with hepatotoxicity, partly also with severe hepatotoxicity. Our data do not allow to account for patient-related risk factors for drug-associated liver injury. This should be addressed in further studies.

Psychiatric disorders are widely underreported diseases, especially in their early stages. So far, there is no fluid biomarker to confirm the diagnosis of these disorders. Proteomics data suggest the synaptic protein glutamate receptor 4 (GluR4), part of the AMPA receptor, as a potential diagnostic biomarker of major depressive disorder (MDD). A novel sandwich ELISA was established and analytically validated to detect GluR4 in cerebrospinal fluid (CSF) samples. A total of 85 subjects diagnosed with MDD (n = 36), bipolar disorder (BD, n = 12), schizophrenia (SCZ, n = 12) and neurological controls (CON, n = 25) were analysed. The data exhibited a significant correlation (r = 0.74; CI:0.62 to 0.82; p < 0.0001) with the antibody-free multiple reaction monitoring (MRM) mass spectrometry (MS) data. CSF GluR4 levels were lower in MDD (p < 0.002) and BD (p = 0.012) than in CON. Moreover, subjects with SCZ described a trend towards lower levels than CON (p = 0.13). The novel GluR4 ELISA may favour the clinical application of this protein as a potential diagnostic biomarker of psychiatric disorders and may facilitate the understanding of the pathophysiological mechanisms behind these disorders.

ZUSAMMENFASSUNGKognitive Kontrollprozesse sind wichtig, um eine Vielzahl an Alltagssituationen erfolgreich zu bewältigen. Bei psychischen Erkrankungen wie Schizophrenie oder Depression wurden Defizite in diesen Kontrollfunktionen beschrieben, wobei das kognitive Syndrom bei Depression in der klinischen Praxis häufig weniger Beachtung findet. In den vergangenen Jahren wurde den neuronalen Oszillationen als Korrelat für kognitive Kontrollleistungen vermehrt Aufmerksamkeit gewidmet und deren Veränderungen bei psychischen Erkrankungen untersucht. Die oszillatorische elektrische Hirnaktivität, also rhythmische Veränderungen neuronaler Aktivität, kann mit dem Elektroenzephalogramm (EEG) gemessen werden. In der Forschung kristallisierte sich dabei die oszillatorische Aktivität im Theta-Frequenzband als neuronales Korrelat von kognitiven Kontrollfunktionen und als wichtig für neuronale Kommunikation heraus. Befunde zeigen, dass Patienten mit Schizophrenie während der Lösung kognitiver Konflikte pathologische Veränderungen in diesem Frequenzband aufweisen. Bei Patienten mit Depression konnten diese Veränderungen noch nicht in solcher Deutlichkeit beschrieben werden. Der vorliegende Artikel führt in grundlegende Konzepte ein und beschreibt neuronale Oszillationen als Biomarker psychischer Erkrankungen, der zur Verbesserung der Diagnostik und Behandlung kognitiver Defizite beitragen könnte.

Purpose Most psychiatric drugs, such as antidepressants (AD) and antipsychotics (AP), may cause cardiac adverse events (CAE). We used summaries of product characteristics (SmPC) for assessing the likelihood of AD and AP to cause CAE. Methods We identified all original medicinal products (OMP) of AD and AP approved in Germany. We searched for their SmPCs using the online services of PharmaNet.Bund, Gelbe liste®, Rote Liste®, Fachinfo-Service®, and via manufacturer contact. We extracted frequencies of reported CAE (QT prolongation, Torsade de Pointes tachycardia, and ventricular arrhythmia) and performed a risk assessment. Results We obtained the SmPCs of 24 AD and 26 AP identified as OMP. Comparably high reported frequencies regarding QT prolongation were found for Invega® (paliperidone), Serdolect® (sertindole) (≥ 1/100 and Conclusion The risk and frequency of CAE, as reported in the SmPCs, varied significantly among substances and between groups. There are more reports for AP than AD. The AP with the most frequently reported CAE (QT prolongation and Torsade de Pointes tachycardia) was Serdolect®; for AD, Zoloft® (QT prolongation, Torsade de Pointes tachycardia) and Trevilor® (Torsade de Pointes tachycardia and ventricular tachycardia) carried a higher cardiac risk.

Background Quantitative (e.g. increasing recreational cannabinoid use) and qualitative (e.g. increasing availability and use of synthetic cannabinoids and cannabis preparations with increased tetrahydrocannabinol content) changes in cannabinoid use may be associated with changes in the prevalence of cannabinoid-related mental and behavioural disorders and, accordingly, changes in the need for medical care. We aimed to investigate if there are changes in the number of inpatient cases (ICs) due to cannabinoid-related disorders in Germany. Methods Data were obtained from the Federal Statistical Office of Germany (Destatis) and comprised type and number of hospital main diagnoses (according to ICD-10) of all ICs in Germany in the period 2000–18. Linear trend analysis of absolute and relative annual frequencies (AFs) of ICs with diagnoses related to the use of cannabinoids (DRUCs), and, as controls, alcohol-related psychiatric disorders and schizophrenia-spectrum disorders was performed. Results Absolute AFs of ICs with DRUCs increased statistically significantly (P Conclusions Our evaluation demonstrates increasing numbers of ICs with mental and behavioural disorders due to use of cannabinoids in Germany and emphasizes the need for adequate prevention of such disorders.

Zusammenfassung Hintergrund Die Fachinformationen (FI) wirkstoffgleicher Arzneimittel konnen inhaltliche Unterschiede aufweisen. Dies kann bei Verordnungen von Arzneimitteln im Rahmen der Aut-idem-Regelung zu Schwierigkeiten fur die arztliche Aufklarung fuhren. Zur Beurteilung des Nutzungsverhaltens von FI, der zur Informationsbeschaffung uber Arzneimittel herangezogenen Quellen und der Kenntnis von der Existenz von Unterschieden zwischen FI wirkstoffgleicher Arzneimittel wurde eine Befragung von Hausarzten (HA) und Apothekern (AP) durchgefuhrt. Methode Es wurde ein explorative/nicht-reprasentative, fragenbogengestutzte, telefonbasierte, semistrukturierte Querschnittsbefragung durchgefuhrt (Juni bis August 2018). Ergebnisse Die Teilnahmequoten lagen bei 29,8% (34/114) der HA bzw. 73,0% (73/100) der AP. Im letzten Monat hatten alle AP und 82,4% der HA mindestens einmal eine FI genutzt (p = 0,001). Die HA gaben an, FI monatlich 6,4 ± 4,9 Mal zu nutzen, AP 65,0 ± 52,5 Mal (p Diskussion Die Ergebnisse der vorliegenden Befragung ergaben Hinweise auf eine geringe Nutzung von FI durch HA sowie geringe Kenntnis von der Existenz von Unterschieden zwischen FI wirkstoffgleicher Handelspraparate in dieser Berufsgruppe. Beide Aspekte konnen zu einer nicht ordnungsgemasen Aufklarung fuhren, insbesondere bei der Aut-idem-Verordnung von Substanzen, fur die zahlreiche wirkstoffgleiche Handelspraparate mit unterschiedlichen FI verfugbar sind. Schlussfolgerung Arzte sollten FIs regelmasig nutzen und uber Unterschiede zwischen FIs wirkstoffgleicher Handelspraparate informiert sein.

Introduction The neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition associated to the use of antipsychotics. Since it requires rapid and efficient medical care, high-quality treatment guidelines should be available. In this article, we analyzed and compared different international therapy guidelines for the treatment of schizophrenia, in which NMS treatment recommendations might be contained. Methods We performed an Internet-based search for schizophrenia guidelines via the website of the respective medical society. Guidelines in English, French, Italian, and German from countries whose medical care meets high standards were selected for further analysis and comparison of the NMS treatment recommendations (if present), and their underlying evidence. Results The NMS is mentioned in 12 of 14 guidelines. Only 9 report concrete therapy recommendations (benzodiazepines/dantrolene/bromocriptine/amantadine/intensive care and/or electroconvulsive therapy (ECT)), however, with high heterogeneity. Only 5 guidelines included all possible drug therapy options and ECT, but with differing combination strategies, dosages, application forms, and combinability of options. The level of evidence of the different recommendations was estimated as low. Discussion One-third of the selected guidelines do not report any NMS therapy recommendations. Most guidelines mentioning the NMS do not provide therapy recommendations that include all relevant treatment options. The results show a very high heterogeneity, and the recommendations and statements are of low-evidence levels. The lack of knowledge about the NMS and its treatment may delay the onset of therapy, impair the quality of treatment, and lead to a worse outcome or death.

Oxytocin (OT) is a neuropeptide associated with trauma, sociality, and depression. Despite the widely accepted assumption of OT playing a role in the etiology of mood and anxiety disorders, associations between stressful life events, depression, and epigenetic regulation of the gene coding for OT (OXT) have not yet been investigated. We therefore aimed to examine the interrelations of stressful life events, depression severity, and methylation of the promoter region of OXT in a sample of N = 146 inpatients suffering from major depression. We found significant negative associations of stressful life events with mean methylation status as well as with methylation status of single CpG sites in the promoter region of OXT. There was no association between depression severity and OXT methylation. However, there were significant sex differences in methylation status of OXT with women showing higher methylation rates than men, putatively suggesting that in depression OXT is less activated in females compared to males. These results speak against an association of OXT methylation and depression severity, but support the assumption of a dysregulation of the OT system due to life stress. Our findings further emphasize the importance of including sex as an important factor in the investigation of the interrelations between OXT, stress, and depression.

IntroductionAlterations in the cholinergic metabolism may cause various clinical symptoms of schizophrenia. In addition to the ‘monoamine hypothesis,’ neuroinflammation is also discussed as a cause of schizophrenia. To date, there has been no evidence of alterations in the central cholinergic transmitter balance in patients with schizophrenia under clinical conditions. By contrast, studies in critically ill patients have established the measurement of acetylcholinesterase activity as a suitable surrogate parameter of central cholinergic transmitter balance/possible pathophysiological changes. Butyrylcholinesterase activity has been established as a parameter indicating possible (neuro)inflammatory processes. Both parameters can now be measured using a point-of-care approach. Therefore, the primary objective of this study is to investigate whether acetylcholinesterase and butyrylcholinesterase activity differs in patients with various forms of schizophrenia. Secondary objectives address the possible association between acetylcholinesterase and butyrylcholinesterase activity and (1) schizophrenic symptoms using the Positive and Negative Syndrome Scale, (2) the quantity of antipsychotics taken and (3) the duration of illness.Methods and analysisThe study is designed as a prospective, observational cohort study with one independent control group. It is being carried out at the Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Germany. Patient enrolment started in October 2020, and the anticipated end of the study is in January 2022. The enrolment period was set from October 2020 to December 2021 (extension required due to SARS-CoV-2 pandemic). The sample size is calculated at 50 patients in each group. Esterase activity is measured on hospital admission (acute symptomatology) and after referral to a postacute ward over a period of three consecutive days. The matched control group will be created after reaching 50 patients with schizophrenia. This will be followed by a comprehensive statistical analysis of the data set.Ethics and disseminationThe study was registered prospectively in the German Clinical Trials Register (DRKS-ID: DRKS00023143,URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023143) after approval by the ethics committee of the University of Ulm, Germany Trial Code No. 280/20.Trial registration numberDRKS00023143; Pre-results., publishedVersion

Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health.Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used.Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found.Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived.Mobbing am Arbeitsplatz gilt als interpersoneller Stressfaktor. Beruflicher Stress und mentale Gesundheit bei Ärztinnen und Ärzten rücken zunehmend in den Fokus der Öffentlichkeit. Inwiefern Mobbing dabei eine Rolle spielt ist noch kaum untersucht. Die Studie soll daher Daten zu Prävalenz von Mobbing unter KlinikärztInnen in Deutschland und möglichen Zusammenhängen mit beruflichem Stress und mentaler Gesundheit liefern.Im Rahmen zweier Querschnittstudien wurden 692 KlinikärztInnen des Fachgebietes Psychiatrie/Psychotherapie (P/PT) und 667 KlinikärztInnen der Intensivmedizin (IM) auf Kongressen befragt. Zum Einsatz kamen standardisierte Fragebögen zu Mobbingerfahrung, Berufsstress und mentaler Gesundheit (Einzelitem aus dem COPSOQ, BDI-II, ERI, MBI).Mobbing erlebten 4,6% (N=61) der Befragten. In der Tendenz sind IM und Frauen häufiger betroffen (nicht signifikant) und es zeigten sich Korrelationen mit Berufsstress (ERI), Overcommitment (OC), Emotionaler Erschöpfung (MBI) und Depressivität (BDI-II).Unsere Daten an einer großen Kohorte von Ärztinnen und Ärzten in Fachgebieten mit unterschiedlichem Belastungsprofil zeigen, dass ein nicht unerheblicher Anteil von Mobbing betroffen ist und Mobbing in Zusammenhang mit dem Erleben von Berufsstress sowie Beeinträchtigungen der mentalen Gesundheit stehen. Daraus lassen sich Implikationen zu institutionellen und individuellen Präventions- und Unterstützungsangeboten ableiten.

Globalization and health 17(1), 117 (2021). doi:10.1186/s12992-021-00768-3, Published by BioMed Central, London

Background: Interventions for improving reporting and management of adverse drug reactions (ADRs) need regular evaluations of attitude and knowledge of health care professionals regarding pharmacov...

Zusammenfassung Gegenstand und Ziel Bei Verordnungen von Arzneimitteln im Rahmen der Aut-idem-Regelung ist für den Arzt häufig unklar, welches wirkstoffgleiche Handelspräparat in der Apotheke abgegeben wird; die in Frage kommenden wirkstoffgleichen Handelspräparate können sich jedoch in zahlreichen Merkmalen unterscheiden, was Fragen in Bezug auf die Aufklärungspflicht und Arzthaftung aufwirft. Gegenwärtig fehlen systematische Auswertungen in Bezug auf Unterschiede zwischen Fachinformationen (FI) wirkstoffgleicher Handelspräparate. Zur Bestimmung von Größe und Art von derartigen Unterschieden wurden FI der meisten in Deutschland zugelassenen (Neuro-)Psychopharmaka exemplarisch hinsichtlich der aufgeführten Anzahl von Kontraindikationen (KI) untersucht. Methodik Grundlage für die Selektion von Wirkstoffen war das Anatomisch-Therapeutisch-Chemische (ATC) Klassifikationssystem (Gruppe ATC N Nervensystem). Eingeschlossen wurden Wirkstoffe, die in Deutschland zur Behandlung psychischer Störungen gemäß ICD-10 F zugelassen sind. Anhand weiterer Ein- und Ausschlusskriterien erfolgte die Suche von Handelspräparaten und FI mithilfe der Online-Dienste von PharmNet.Bund, Gelber Liste, Roter Liste®/Fachinfo-Service® und über Herstellerkontakt. Ergebnisse Es wurden n = 941 FI (= 116 Wirkstoffe) ausgewertet. Bei alleiniger Betrachtung der Gruppen von FI wirkstoffgleicher Handelspräparate mit > 1 eingeschlossenen FI (n = 78; 67,2 %) fanden sich bei mehr als der Hälfte der Wirkstoffe (n = 43; 55,1 %) Unterschiede in der Anzahl der KIs. Innerhalb der Indikationsgruppen fanden sich die meisten Gruppen von FI wirkstoffgleicher Handelspräparate mit Unterschieden in der Anzahl der KIs – nur Wirkstoffe mit > 1 wirkstoffgleichen Handelspräparat berücksichtigend – bei den Hypnotika und Sedativa (77,8 %), Anxiolytika (75,0 %), Mittel zur Behandlung von Abhängigkeitserkrankungen (66,7 %), Antidepressiva (61,9 %), Antikonvulsiva und Phasenprophylaktika (53,8 %), gefolgt von den Antipsychotika (41,2 %), Antidementiva (20,0 %) und Psychostimulantien (0 %). Die größten Spannweiten bei der Anzahl der aufgeführten KIs fanden sich bei den FI von Morphin (14), Amitriptylin (8), Chlorprothixen (6), Lorazepam (6) und Citalopram (4). Schlussfolgerung(en) Bei zahlreichen (neuro-)psychopharmakologischen Wirkstoffen bestehen zwischen den FI der zugehörigen wirkstoffgleichen Handelspräparate Unterschiede in der Anzahl von KIs. Die Relevanz dieses Ergebnisses für die klinische Praxis ist infolge ausstehender Bewertung der inhaltlichen Aspekte und juristischer Bewertung dieser Unterschiede noch unklar.

When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.

Gegenstand und Ziel: Blutungsereignisse unter Therapie mit Antidepressiva, die die Serotoninwiederaufnahme hemmen (SRI), sind in den Fokus der klinischen und wissenschaftlichen Aufmerksamkeit geruckt. In der vorliegenden Ubersichtsarbeit wird ein Uberblick uber den Kenntnisstand zu SRI-assoziierten Blutungen, insbesondere in Hinblick auf moglichen Pathomechanismen und verschiedene Blutungslokalisationen gegeben. Material und Methoden: Es wurde eine narrative Ubersichtsarbeit erstellt. Die Literaturrecherche wurde in der bibliografischen Datenbank MEDLINE durchgefuhrt. Ergebnisse: Zahlreiche Studien deuten darauf hin, dass SRI, insbesondere SSRI, das Risiko fur obere gastrointestinale Blutungen erhohen konnen; eine Komedikation mit NSAID oder Thrombozytenaggregationshemmern erhoht dieses Risiko deutlich. Die Datenlage zu anderen Blutungslokalisationen ist fur sichere Bewertungen gegenwartig unzureichend. Es gibt Hinweise auf einen positiven Zusammenhang zwischen der Affinitat eines SRI zum Serotonintransporter (5-HTT) und dem assoziierten Blutungsrisiko. Schlussfolgerungen und klinische Relevanz: Ein erhohtes Risiko fur Blutungen (insbesondere obere gastrointestinale Blutungen) durch SRI sowie eine Erhohung dieses Risikos durch NSAID und/oder Thrombozytenaggregationshemmer sollte bei der Verordnung von SRI, insbesondere von SRI mit hoher Affinitat zum 5-HTT (z. B. SSRI), beachtet werden. Objective: Hemorrhages associated with the use of antidepressants that inhibit serotonin reuptake (SRI) have become a focus of attention in clinical practice and science. This review article provides an overview of the currently available data regarding bleeding events associated with SRI with a focus on pathophysiology and different sites of bleeding. Material and methods: A narrative review article was created. Literature search was performed in the bibliographic database of MEDLINE. Results: Numerous studies have demonstrated an increased risk for upper gastrointestinal bleeding related to SRI, particularly, SSRI; comedication with NSAID or anti-platelet agents increases this risk remarkably. The currently available data does not allow reliable evaluation regarding other sites of bleeding. There is indication for an association between the affinity of an SRI to the serotonin transporter (5-HTT) and the associated risk of bleeding. Conclusion: An increased bleeding risk of bleeding (particularly upper gastrointestinal bleedings) associated with the use of SRI and an additionally increased risk under comedication with NSAID and/or antiplatelet agents should be taken into account, especially regarding SRI with high affinity to the 5-HTT (e. g., SSRI).

Background Major depressive disorder (MDD) is a severe health condition that affects millions of people worldwide. Etiologically, several factors may play a role in its development. Previous studies reported elevated plasminogen activator inhibitor-1 levels in patients with depression, suggesting that plasminogen activator inhibitor-1 levels might be linked to the etiology of MDD. Methods We systematically searched the following online databases: Medline, Scopus, and Web of Science up to September 10, 2020, to identify the studies in which the level of plasminogen activator inhibitor-1 was reported in subjects with MDD. Subsequently we used RevMan 5.3 for performing a meta-analysis of data extracted from the included studies using PRISMA and PICO criteria for the search and analysis. Results Six studies that reported mean ± SD were included in the analysis with 507 MDD patients and 3453 controls. The overall standardized mean difference was 0.27 (95% CI 0.01, 0.53). Plasminogen activator inhibitor-1 serum level was 0.27 SDs higher in MDD patients than in controls. The test for overall effect was significant (z = 2.04, p = 0.04). Substantial heterogeneity was detected in the studies showed through the Inconsistency test (I2 = 72%), and the Chi-Square test (X2 = 18.32; p = 0.003). Conclusions This systematic review and meta-analysis showed that MDD might be related to elevated plasminogen activator inhibitor-1 levels. We propose larger prospective clinical studies to further investigate this clinical correlation and validate those observations' clinical significance.

Background: Physicians, especially psychiatrists, have a high risk of job-related stress, and mental impairment. In our study we examined changes in private and occupational stress factors and mental health within a decade. The legislative reduction of physicians' working hours in Germany during this period made it possible to investigate the impact of working hours in particular. Methods: Questionnaires were administered at two psychiatrist meetings (2006 and 2016) about job and family situation, depressiveness, burnout and effort-reward imbalance. A total of N = 1,797 datasets were analyzed. Results: Working hours and free weekends were associated with mental health indices. Correlation analyses showed that a reduction in weekly working hours and working days at weekends was related to reduced scores for effort-reward-imbalance, burnout and depression. Conclusions: Our data show changes in workplace stress and mental health in psychiatrists in a decade in which a reduction in working hours has been required by law. These results can provide indications of effective prevention strategies in the professional context of physicians working in psychiatry.